Determinants of Willingness to Pay Thresholds in NICE Oncology Technology Appraisals
Author(s)
Helen Bewicke-Copley, MSc1, Fern Woodhouse, MSc MChem2, Emma New, BA3, Amrit Heir, MSci4, Briana Tan, BSc3, Jamie Graham, MSci5, Josh Micallef, MSc2, Alex Porteous, BA, MSc5.
1Costello Medical, Edinburgh, United Kingdom, 2Costello Medical, Cambridge, United Kingdom, 3Costello Medical, Singapore, Singapore, 4Costello Medical, Manchester, United Kingdom, 5Costello Medical, London, United Kingdom.
1Costello Medical, Edinburgh, United Kingdom, 2Costello Medical, Cambridge, United Kingdom, 3Costello Medical, Singapore, Singapore, 4Costello Medical, Manchester, United Kingdom, 5Costello Medical, London, United Kingdom.
OBJECTIVES: NICE considers uncertainty, uncaptured benefits, non-health factors and health inequalities when selecting an appropriate willingness to pay threshold (WTPT) for technology appraisals where the most plausible incremental cost-effectiveness ratio (ICER) is above £20,000 per QALY. This research explored determinants of WTPT selection in recent NICE oncology appraisals.
METHODS: The NICE website was searched on 11 June 2025 for completed oncology appraisals published since 1 January 2023. Appraisals involving managed access or former end of life criteria were excluded. The chosen WTPT and rationale were extracted.
RESULTS: WTPTs were set at £20,000 for 12/73 (16%), £25,000 for 16/73 (22%) and £30,000 for 21/73 (29%) appraisals. No specific WTPT was stated for 24/73 (33%) appraisals. The proportion of appraisals with specified WTPTs increased over time (2023: 9/22 [41%], 2024: 23/31 [74%], 2025: 17/20 [85%]). In appraisals with a specified WTPT where the committee described uncertainty as “high”, 8/21 (38%) and 3/21 (14%) were assigned WTPTs of £20,000 and £30,000, respectively, compared with 0/7 (0%) and 6/7 (86%) where uncertainty was described as “low”, and 4/21 (19%) and 12/21 (57%) where uncertainty was not explicitly quantified. All three appraisals with high uncertainty and a £30,000 WTPT cited high unmet need or uncaptured benefits as contributing to WTPT decision-making; one cited both. Committees acknowledged high unmet need and uncaptured benefits in 2/12 (17%) and 1/12 (8%) £20,000 WTPT appraisals, respectively, all of which had high uncertainty.
CONCLUSIONS: Reporting of specific WTPTs increased over time. Among appraisals with a specified WTPT, high uncertainty was typically associated with lower WTPTs. However, higher WTPTs could be selected in high uncertainty appraisals where high unmet need or uncaptured benefits were accepted by the Committee. The impact of these factors on the WTPT appears to be inconsistent however, with lower WTPTs sometimes selected despite acknowledgement of high unmet need or uncaptured benefits.
METHODS: The NICE website was searched on 11 June 2025 for completed oncology appraisals published since 1 January 2023. Appraisals involving managed access or former end of life criteria were excluded. The chosen WTPT and rationale were extracted.
RESULTS: WTPTs were set at £20,000 for 12/73 (16%), £25,000 for 16/73 (22%) and £30,000 for 21/73 (29%) appraisals. No specific WTPT was stated for 24/73 (33%) appraisals. The proportion of appraisals with specified WTPTs increased over time (2023: 9/22 [41%], 2024: 23/31 [74%], 2025: 17/20 [85%]). In appraisals with a specified WTPT where the committee described uncertainty as “high”, 8/21 (38%) and 3/21 (14%) were assigned WTPTs of £20,000 and £30,000, respectively, compared with 0/7 (0%) and 6/7 (86%) where uncertainty was described as “low”, and 4/21 (19%) and 12/21 (57%) where uncertainty was not explicitly quantified. All three appraisals with high uncertainty and a £30,000 WTPT cited high unmet need or uncaptured benefits as contributing to WTPT decision-making; one cited both. Committees acknowledged high unmet need and uncaptured benefits in 2/12 (17%) and 1/12 (8%) £20,000 WTPT appraisals, respectively, all of which had high uncertainty.
CONCLUSIONS: Reporting of specific WTPTs increased over time. Among appraisals with a specified WTPT, high uncertainty was typically associated with lower WTPTs. However, higher WTPTs could be selected in high uncertainty appraisals where high unmet need or uncaptured benefits were accepted by the Committee. The impact of these factors on the WTPT appears to be inconsistent however, with lower WTPTs sometimes selected despite acknowledgement of high unmet need or uncaptured benefits.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HTA105
Topic
Economic Evaluation, Health Technology Assessment
Topic Subcategory
Decision & Deliberative Processes
Disease
Oncology